A QUESTION OF ACCESS

WHAT ACCESS MEANS IN THE UNITED STATES

ACCESS IS RESTRICTED TO THOSE WHO HAVE HEALTH INSURANCE THROUGH THEIR EMPLOYERS

  THOSE COVERED UNDER A

GOVERNMENT HEALTH CARE PROGRAM.

 

THOSE WHO CAN AFFORD TO BUY INSURANCE OUT OF THEIR OWN PRIVATE FUNDS, AND

  THOSE WHO ARE ABLE TO PAY

FOR SERVICES PRIVATELY.

Some Statistics about access

Health Insurance Coverage in the U.S., 2006

Medicaid/ Other Public

12%

Medicare14%

Private Non-Group5%

Uninsured16%

Employer-Sponsored Insurance

54%

NOTE: Includes those over age 65. Medicaid/Other Public includes Medicaid, SCHIP, other state programs, and military-related coverage. Those enrolled in both Medicare and Medicaid (1.8% of total population) are shown as Medicare beneficiaries. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Total = 296.1 million

IL

Uninsured Rates Among the Nonelderly,

by State, 2005-2006

AZAR

MS

LA

WA

MN

ND

WY

ID

UTCO

OR

NV

CA

MT

IA

WIMI

NE

SD

ME

MOKS

OHIN

NY

KY

TNNC

NH

MA

VT

PA

VAWV

CTNJ

DE

MD

RI

HI

DC

AK

SCNM

OK

GA

SOURCE: Kaiser Commission on Medicaid and the Uninsured and Urban Institute analysis of the March 2006 and 2007 Current Population Survey. Two-year pooled estimates for states and the US (2005-2006).

TX

FL

AL

13-17% (18 states & DC)

18%-20% (9 states)

< 13% (13 states)

US Average = 18%

NE

>20% (10 states)

1%4%

2%4%

12%

37%

13%

2% 2%2%4%

17%

4%7%

12%

23%

30%

17%

No Usual Placeof Care

PostponedSeeking CareDue to Cost

Needed Carebut Did Not Getit Due to Cost

Last MDContact >2Years Ago

Unmet DentalNeed

Last DentalVisit >2 Years

Ago

Employer/ Other Private Medicaid/ Other Public Uninsured

Children’s Access to Care, by Health Insurance Status, 2006

NOTE: MD contact includes MD or any health care professional, including time spent in a hospital. Data is for all children under age 18, except for dental visit and unmet dental need, which are for children age 2-17. Respondents who said usual source of care was the emergency room were included among those not having a usual source of care. All estimates are age-adjusted.SOURCE: Kaiser Commission on Medicaid and the Uninsured analysis of National Center for Health Statistics, CDC. 2007. Summary of Health Statistics for U.S. Children: NHIS, 2006.

Characteristics of the Uninsured, 2006

400% FPL+11%

200-399% FPL24%

100-199% FPL29%

<100% FPL36%

Family IncomeFamily Work Status

Total = 46.5 million uninsured

1 or More Full-Time Workers

71%

No Workers

18%

Part-TimeWorkers

11%

Age

55-649%

35-5432%

19-3439%

0-1820%

The federal poverty level was $20,614 for a family of four in 2006. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Health Insurance Coverageof the Nonelderly by Poverty Level,

2006

43%

70%

37% 30%18% 11%

91%

21%

83%

11%

26%

3%

43%

6%

5%

0%

25%

50%

75%

100%

<100%FPL

100-199%FPL

200-299%FPL

300-399%FPL

400% +FPL

Uninsured

Medicaid/ OtherPublic

Employer/ OtherPrivate

NOTE: The federal poverty level (FPL) was $20,614 for a family of four in 2006. Data may not total 100% due to rounding. Nonelderly defined as age 0-64.SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

The Nonelderly Uninsured,by Age and Income Groups, 2006

Other Children

6%

Low-IncomeParents 17%

Low-IncomeAdults

without Children

34%

Other Adults without Children

21%

Low-IncomeChildren

14%

Other Parents

8%

Total = 46.5 million uninsured

Low-income includes those with family incomes less than 200% of the federal poverty level. SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Number of Nonelderly Uninsured Americans,2004 - 2006

34.6 37.0

8.4 8.7 9.4

35.6

2004 2005 2006

ChildrenAdults

Uninsured in Millions

SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March CPS for each year.

43.0 44.446.5

45%64%

33%

16%

4%13%15%

5%

Uninsured All Nonelderly

Uninsured Nonelderly vs. All Nonelderly,

by Race and Ethnicity, 2006

NOTES: American Indian category includes Aleutian Eskimos. Data may not total 100% due to rounding.SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Black

Multiracial (1%)

White

Hispanic

Am. Indian (1%)Asian

2%

1%

46.5 Million 260.0 Million

Private Non-group, 6%

Employer-sponsored Insurance,

63%

Medicaid/ Other Public,

11%

Uninsured, 20%

Health Insurance Coverage ofNonelderly Adults, 2006

181.8 Million Nonelderly Adults

SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

Adults' Health Insurance Coverage by Household Type,

2006

77%

47%

49%

77%

68%

54%

7%

24%

18%

9%

14%

11%

15%

29%

33%

18%

35%

15%

Private Medicaid/Public Uninsured

13.1 M

59.3 M

53.7 M

19.6 M

28.9 M

Number

7.2 M

Married, no children

Other with children

2 parents with children

1 parent with children

Adults, living together

Adults, living alone

NOTES: Other households with children include families with at least three generations in a household, plus families in which adults are caring for children other than their own (e.g., a niece living with her aunt). Adults includes all individuals aged 19 to 64. Data may not total 100% due to rounding.SOURCE: Kaiser Commission on Medicaid and the Uninsured/Urban Institute analysis of March 2007 CPS.

30%

92%

55%

4%

15%

4%

Poor Workers Higher Income Workers

Covered by Ownor Spouse'sEmployer

Declined offerfrom Own orSpouse'sEmployer

Not offeredthrough Own orSpouse'sEmployer

Access to Employer-Based Coverage by Family Income, 2005

NOTE: The Federal Poverty Level (FPL) was $16,090 for a family of three in 2005.SOURCE: Garrett B. and L. Clemens-Cope. Changes in Employer-Sponsored Health Insurance Coverage: 2001-2005. Kaiser Commission on Medicaid and the Uninsured report #7599, Dec. 2006

(Family Income <100% FPL)

(Family Income 400%+ FPL)

FLORIDA’S UNINSURED

FLORIDA HAS THE 3rd LARGEST UNINSURED POULATION IN THE NATION

17.8 % OF FLORIDA’S NON-ELDERLY POPULATION DOES NOT HAVE HEALTH INSURANCE COVERAGE

IN 2008, 18.8% OF FLORIDA’S CHILDREN WERE UNINSURED

43% OF FLORIDIANS AGES 21-24 DO NOT HAVE HEALTH INSURANCE

ETHNIC GROUPS WITHOUT HEALTH INSURANCE

HISPANIC – 32% BLACKS – 31% WHITES – 19%

EARLY RETIREES ARE A RAPIDLY GROWING GROUP OF UNINSURED FLORIDIANS. FEWER EMPLOYERS ARE PROVIDING HEALTH BENEFITS FOR EARLY RETIREES.

75% OF FLORIDA’S UNINSURED ARE EMPLOYED.

THE VAST MAJORITY OF EMPLOYERS ARE SMALL AND ARE LESS LIKELY TO PROVIDE HEALTH CARE INSURANCE.

WHY ARE PEOPLE LOSING HEALTH CARE INSURANCE?

WHEN HEALTH CARE COSTS RISE FASTER THAN WAGES THERE IS A DECREASE IN INSURANCE COVERAGE. LOW INCOME WORKERS CANNOT AFFORD TO BUY HEALTH CARE INSURANCE.

COST OF HEALTH INSURANCE PREMIUMS IS THE PRIMARY REASON PEOPLE DO NOT HAVE HEALTH INSURANCE COVERAGE. BECAUSE OF COST INCREASES, EMPLOYERS ARE SHIFTING MORE OF THE COST OF COVERAGE TO EMPLOYEES.

WHEN PREMIUM COSTS RISE, EMPLOYERS OF ALL SIZES ARE LIKELY TO SWITCH FROM CONVENTIONAL COVERAGE TO MANAGED CARE PLANS, RESTRICT HEALTH PLAN ELIGIBILITY (NO COVERAGE FOR PART-TIME OR TEMPORARY WORKERS), AND INCREASE COST-SHARING REQUIREMENTS.

SOME EMPLOYERS ARE ELIMINATING COVERAGE FOR DEPENDENTS OR SHIFTING THE ENTIRE COST TO THE EMPLOYEE.

MORE EMPLOYERS USE CONTRACT OR PART-TIME EMPLOYEES WHO ARE NOT ELIGIBLE FOR COVERAGE.

WELFARE REFORM IS MOVING PEOPLE OFF WELFARE AND INTO JOBS. IN MANY CASES, THEY TEND TO MAKE TOO MUCH INCOME TO QUALIFY FOR MEDICARE. THE JOBS THEY TAKE DON’T ALWAYS OFFER INSURANCE.

IMPLICATIONS OF BEING UNINSURED

MOST PEOPLE WHO LACK HEALTH CARE COVERAGE RECEIVE LITTLE OR NO PREVENTATIVE CARE. THEY ARE LESS LIKELY TO FILL A PRESCRIPTION OR RETURN FOR FOLLOW UP CARE.

THE EMERGENCY ROOM BECOMES THE SOURCE OF PRIMARY CARE

HEALTH CONDITIONS THAT GO UNMANAGED CAN RESULT IN SERIOUS CONDITIONS REQUIRING HOSPITALIZATION.

EMERGENCY ROOM CARE REPRESENTS 7% OF ALL PATIENTS ADMITTED TO FLORIDA HOSPITALS.

IMPLICATIONS FOR THE FUTURE

THE 1998 STATE LEGISLATURE PASSED THE “FLORIDA KID CARE PROGRAM”

ENROLLING THEM REMAINS A CHALLENGE.

INCREASES IN HEALTH INSURANCE COSTS WILL RESULT IN MORE PEOPLE BEING UNABLE TO AFFORD COVERAGE.

HOSPITALS, FACING LOWER PAYMENTS FROM MEDICARE, MEDICAID AND MANAGED CARE COMPANIES, WILL STRUGGLE TO ABSORB THE COST OF CARING FOR THE UNINSURED.

PROGRAMS FOCUSING ON PRIMARY AND PREVENTATIVE CARE FOR THE UNINSURED POPULATIONS WILL BE THE KEY TO MANAGING THE COST OF CARING FOR THESE PATIENTS.

TAX INCENTIVES TO ENCOURAGE INDIVIDUALS WILL RESULT IN MORE AFFORDABLE COVERAGE.

SPECIAL FUNDING MUST BE AVAILABLE TO THE “SAFETY NET” HOSPITALS, I.E., THOSE HOSPITALS WHO SERVE A DISPROPORTIONATE AMOUNT OF UNINSURED PATIENTS.

Key Points to Remember

Most of the uninsured either work or come from a working family.

There is a higher incidence of un-insurance in the low-income, younger adults, and minority populations.

Most of the uninsured are U.S. citizens

Loss of health care delivery capacity

Less effective control of communicable diseases.

Losses to the community’s economic base.

Being uninsured effects the emotional health of individuals and families by:

Creating a fear of being denied health care or being bankrupt by illness

Forcing individuals to choose which medical services to utilize.

Internal Costs to individuals, families, and business firms

Greater morbidity and premature mortality

Developmental losses for children

Family financial uncertainty and stress, depletion of assets.

Lost income or uninsured breadwinner in ill health.

Workplace productivity losses (absenteeism, reduced efficiency on the job)

Diminished sense of social equality and self-respect.

End of Lecture for August 30th

2010, 6th Period

Questions? Discussion?